Jyotiprakas Chattopadhyay

Extracellular mass/body cell mass ratio is an independent predictor of survival in peritoneal dialysis patients.

Malnutrition is a strong predictor of mortality in peritoneal dialysis (PD) patients. Extracellular mass (ECM) contains all the metabolically inactive, whereas body cell mass (BCM) contains all the metabolically active, tissues of the body. ECM/BCM ratio is a highly sensitive index of malnutrition. The objective of this study was to explore the relationship between ECM/BCM ratio and survival in PD patients. We enrolled 62 patients from November 2000 to July 2008. On enrollment, demographic, clinical, and biochemical data were recorded. Bioimpedance analysis (BIA) was used to determine ECM and BCM in PD patients. Patients were followed up to November 2008. Mean age was 54+/-16 (s.d.) years; female, 55%; African Americans, 65%; diabetic, 24%. Mean ECM/BCM ratio was 1.206+/-0.197 (range: 0.73-1.62). Diabetics had higher ECM/BCM ratio than nondiabetics (1.29 vs 1.18, P=0.04). ECM/BCM ratio correlated directly with age (r=0.38, P=0.002) and inversely with serum albumin (r=-0.43, P=0.001), creatinine (-0.24, P=0.08), blood urea nitrogen (r=-0.26, P=0.06), and total protein (r=-0.31, P=0.026). Using multivariate Cox regression analysis, adjusting for age, race, gender, diabetes, and human immunodeficiency virus status, enrollment ECM/BCM ratio was a significant independent predictor of mortality (relative risk=1.035, P=0.018). For every 10% increase in the ECM/BCM ratio, the relative risk of death was increased by about 35%. In conclusion, BIA-derived enrollment ECM/BCM ratio, a marker of malnutrition, was an independent predictor of long-term survival in PD patients.

Body Composition, Nutritional Status and Mortality in Peritoneal DialysisPatients

Background: Protein energy malnutrition is highly prevalent and a risk factor for mortality in peritoneal dialysis (PD) patients. In this study we have investigated the association of body composition parameters with nutritional status and outcomes in PD patients. Methods: We enrolled 63 PD patients between November 2000 to May 2008. On enrollment, demographic, clinical and biochemical data were recorded. Patients were followed to May 2011. Body composition was determined by bioelectrical impedance analysis (BIA). Results: Mean age was 54 years. At enrollment, the mean (± SD) serum albumin, creatinine and nPCR were 3.71 ± 0.59 g/dL, 11.38 ± 4.2 mg/dL and 0.94 ± 0.27 g/kg/day respectively. Mean (± SD) body mass index (BMI), phase angle (PA) and extracellular mass/body cell mass (ECM/BCM) ratio were 25.37 ± 5.46 Lbs/inch2, 6.06 ± 1.6 degrees and 1.21 ± 0.2 respectively. Albumin, and creatinine directly correlated with BMI (p=0.027 for albumin; p<0.0001 for creatinine) and PA (p<0.0001 for albumin; p=0.031 for creatinine) and inversely correlated with ECM/BCM ratio (p=0.001 for albumin; p=0.07 for creatinine). During the study period 26 patients expired. Patients who survived had higher BMI (p=0.05), PA (p=0.017) and lower ECM/BCM ratio (p=0.04) compared to those who expired. In Cox’s multivariate analysis, adjusting for confounding variables, higher levels of PA (Relative risk: 0.52, p=0.009) and lower levels of ECM/BCM ratio (Relative risk: 1.039, p=0.035) were significantly and independently associated with increased survival in PD patients followed up to 11 years. Conclusions: Estimates of BMI, PA and ECM/BCM ratio reflect nutritional status and are important predictors of long term survival in PD patients. It may be useful to incorporate these parameters in the management of malnutrition and overall health in these patients.

209 Serum Fructosamine (SF), But Not Glycosylated Hemoglobin (HbA1C), Predicts Long-Term Survival in Nondiabetic (NDM) Hemodialysis (HD) Patients (PTS)

SERUM FRUCTOSAMINE (SF), BUT NOT GLYCOSYLATED HEMOGLOBIN (HbA1C), PREDICTS LONG-TERM SURVIVAL IN NONDIABETIC (NDM) HEMODIALYSIS (HD) PATIENTS (PTS) Neal Mittman, Brinda Desiraju, Swapna Vemulapalli, Jyotiprakas Chattopadhyay, Morrell M. Avram. Avram Division of Nephrology, Long Island College Hospital, Brooklyn, NY. We and others have reported that the level of SF, an alternative index of glycemic control, is elevated in NDM HD pts. Elevated levels of SF have been associated with increased cardiovascular mortality in elderly non-uremic, NDM women. We have previously reported that SF, but not HbA1c, predicts morbidity (infection and hospitalization) in NDM HD pts. The objective of this study was to investigate the prognostic importance of enrollment SF on long-term survival in NDM HD pts. We enrolled 72 NDM HD pts from February 2005 and followed them to November 2010. SF level was corrected for serum albumin (AlbF) as previously reported. Mean age was 54±16 (SD) yrs, fifty-four percent were women and the majority were African-Americans (81%). Mean values for enrollment SF, AlbF and HbA1c were 286μmol/l (range: 187-378μmol/l) and 742μmol/g (range:468-1076μmol/g) and 5.19% (range: 4.4-5.5%) respectively. During the study period, 21 pts (29%) expired. Pts who died during the study had significantly higher AlbF (810 vs. 721, p=0.004) compared to those who survived. Using Coxs multivariate regression analysis, adjusting for age, race, gender and dialysis vintage, AlbF was a significant independent predictor of mortality (Relative Risk=1.008, p=0.015) in these NDM HD pts. In contrast, HbA1c did not predict mortality (p=0.53) in this population. Variable Relative Risk p Age (years) 1.014 0.61 Gender (Male vs. Female) 2.17 0.25 Race (Others vs. AA) 1.14 0.91 Months on dialysis 1.004 0.37 AlbF (μmol/g) 1.008 0.015 AA= African American In conclusion, AlbF, but not HbA1c, the most commonly utilized measure of glycemic control, predicts long-term survival up to 6 years in these non-diabetic HD pts.